Inmunohistoquímica con anticuerpos monoclonales en mujeres indígenas peruanas con cáncer de mama, para pronosticar sobrevida global / Immunohistochemistry with monoclonal antibodies in peruvian indigenous with breast cancer, to forecast Global Survival

Resumen Objetivo: Aplicar la técnica de anticuerpos monoclonales para HER2/neu (human epidermal growth 2/neuro glioblastoma), en tumores de indígenas nativos de Perú con diagnóstico de cáncer de mama, así como correlacionar la sobreexpresión molecular con la sobrevida global. Pacientes y Métodos: Estudio experimental, prospectivo y analítico. Se evaluaron 23 muestras biológicas de tumores de pacientes indígenas andinos de Arequipa, con diagnóstico definitivo de adenocarcinoma de mama. La expresión del receptor HER2/neu se determinó mediante inmunohistoquímica con anticuerpos monoclonales. Resultados: El 43,4% (10 casos) fueron positivos para sobreexpresión del receptor. Los casos negativos fueron 56,6%. La supervivencia global de las pacientes a los 3 años fue 69,9% cuando los tumores tenían HER2/neu sobreexpresados y 84,6% para los negativos, mostrando diferencia estadísticamente significativa (p=0,017). Conclusiones: La técnica de inmunohistoquímica en tumores mamarios de indígenas andinos puede aplicarse siguiendo los protocolos mundiales. Así mismo, hubo correlación entre la sobreexpresión del receptor HER2/neu con menor sobrevida global. El principal beneficio de esta técnica es justificar el uso de terapia biológica con anticuerpos monoclonales, según el perfil molecular, en población nativa de Arequipa, en un hospital cercano a su residencia.

Abstract Objective: To apply the monoclonal antibody technique for HER2/neu, in tumors of indigenous natives of Peru with breast cancer, as well as to correlate molecular overexpression with global survival. Patients and methods: Experimental, prospective and analytical study. 23 biological samples of tumors from indigenous Andean patients from Arequipa, with a definitive diagnosis of breast adenocarcinoma, were evaluated. HER2/neu expression was determined by immunohistochemistry with monoclonal antibodies. Results: 43.4% (10 cases) were positive for receptor overexpression. The negative cases were 56.6%. The overall survival of the patients at 3 years was 69.9% when the tumors had overexpressed HER2/neu and 84.6% for the negative ones, showing a statistically significant difference (p = 0.017) Conclusions: The immunohistochemical technique in Andean indigenous mammary tumors can be applied following world protocols. Likewise, there was a correlation between the overexpression of the HER2 / neu receptor with lower overall survival. The main benefit of this technique is to justify the use of biological therapy with monoclonal antibodies, according to the molecular profile, in the native population of Arequipa, in a hospital near their residence.

Implicaciones cardiovasculares de la infección por SARS-CoV-2: revisión de literatura / Cardiovascular implications of SARS-CoV-2 infection: a literature review

En diciembre de 2019 se reportó en Wuhan, China, la aparición de una nueva cepa de coronavirus SARS-CoV-2 que producía un compromiso pulmonar severo y progresaba a estrés respiratorio agudo. A la fecha, son más de diecisiete millones los casos confirmados y más de medio millón los fallecidos en todo el mundo a causa de COVID-19. Los estudios reportan que los pacientes con enfermedad cardiovascular son más susceptibles a contraer esta enfermedad y a presentar más complicaciones. El propósito de esta revisión es proporcionar información actualizada para los profesionales de la salud que atienden a pacientes con COVID-19 y que tienen además enfermedad cardiovascular y por ende un riesgo elevado de complicaciones y mortalidad. Realizamos una búsqueda de bibliografía científica acerca de la asociación de enfermedad cardiovascular y COVID-19 en diferentes bases de datos como Scopus, MEDLINE vía PubMed y Cochrane Library. El tratamiento con inhibidores de la enzima convertidora de angiotensina y bloqueadores del receptor de angiotensina ha sido motivo de discusión y no hay evidencia sólida para contraindicarlo en pacientes con COVID-19. Respecto al tratamiento con hidroxicloroquina asociado o no con azitromicina, hay evidencia que demuestra un mayor riesgo con su utilización, que beneficio clínico y/o disminución de mortalidad. En este contexto, los pacientes con insuficiencia cardíaca representan un grupo importante de riesgo por su condición per se y por el dilema diagnóstico generado al evaluar un paciente con COVID-19, en el que los signos de insuficiencia cardíaca aguda podrían enmascararse. Por otro lado, en los pacientes con síndrome coronario agudo, el enfoque terapéutico inicial podría cambiar en el contexto de la pandemia, aunque sólo sobre la base de opiniones de expertos. Quedan, sin embargo, muchos temas en controversia que serán motivo de investigaciones futuras.

In December 2019, a new strain of the SARS-CoV-2 coronavirus was reported in Wuhan, China, which produced severe lung involvement and progressed to respiratory distress. To date, more than seventeen million confirmed cases and more than half a million died worldwide from COVID-19. Patients with cardiovascular disease are more susceptible to contracting this disease and presenting more complications. We did a literature search on the association of cardiovascular disease and COVID-19 in databases such as Scopus, PubMed/MEDLINE, and the Cochrane Library. The purpose of this review is to provide updated information for health professionals who care for patients with COVID-19 and cardiovascular disease, given that they have a high risk of complications and mortality. Treatment with angiotensin-converting enzyme inhibitors and receptor blockers is controversial, and there is no evidence not to use these medications in patients with COVID-19. Regarding treatment with hydroxychloroquine associated or not with azithromycin, there is evidence of a higher risk with its use than clinical benefit and decreased mortality. Likewise, patients with heart failure are an important risk group due to their condition per se. Patients with heart failure and COVID-19 are a diagnostic dilemma because the signs of acute heart failure could be masked. On the other hand, in patients with acute coronary syndrome, the initial therapeutic approach could change in the context of the pandemic, although only based on expert opinions. Nonetheless, many controversial issues will be the subject of future research.

Acoustic radiation force impulse elastography of the eyes of brachycephalic dogs / Elastografia acoustic radiation force impulse dos olhos de cães braquicefálicos

Eyes from brachycephalic dogs were studied by acoustic radiation force impulse (ARFI) elastography to establish quantitative and qualitative reference values related to the shape and rigidity of some ocular structures. Eighty-four eyes from 42 adult brachycephalic dogs were included in this study. Animals were subjected to physical, laboratory, and ophthalmic examinations. Following confirmation of good health, the dogs were subjected to ultrasonography and ARFI elastography, emphasizing the optic nerve, ciliary body, and lens. On qualitative elastography, homogeneous characteristics were observed on the ciliary body and optic nerve. Aqueous and vitreous humors were visualized as mosaic-like images. Quantitative elastography showed the mean optic nerve shear wave velocity (SWV) was 1.01±0.27m/s, temporal ciliary body was 0.91±0.24m/s, and nasal ciliary body was 0.91±0.3m/s. The SWV of the lens values were out of range, this value was not detectable by this software. Elastography has proved to be a non-invasive procedure and feasible in dogs. The establishmentof the parameters of degree of rigidity of ocular structures will serve as a baseline for animals with eye disorders. Results may be extrapolated to primary research on the applicability of ARFI in the evaluation of ocular bulb in humans.(AU)

Estruturas oculares de cães braquicéfalos foram estudadas por elastografia acoustic radiation force impulse (ARFI) para estabelecer valores quantitativos e qualitativos de referência relacionados com a forma e a rigidez de algumas estruturas oculares. Foram avaliados 84 olhos de 42 cães braquicéfalos neste estudo. Os animais foram submetidos aos exames físico, laboratorial e aos exames oftalmológicos. Após a confirmação da sanidade dos pacientes, os cães foram submetidos à ultrassonografia e à elastografia ARFI, enfatizando-se o nervo óptico, o corpo ciliar e a lente. Para elastografia qualitativa, foram observadas características homogêneas no corpo ciliar e no nervo óptico. Os humores aquoso e vítreo foram visibilizados como imagens tipo mosaico. A elastografia quantitativa demonstrou velocidades de cisalhamento para nervo óptico de 1,01±0,27m/s, para corpo ciliar temporal de 0,91±0,24m/s e para corpo ciliar nasal de 0,91±0,3m/s. Valores dessas velocidades para lentes apresentaram-se fora do intervalo: X.XXm/s. A elastografia provou ser um procedimento não invasivo e viável para cães. Estabelecidos os parâmetros do grau de rigidez das estruturas oculares, futuramente tais dados servirão como padrão para avaliação de animais com os distúrbios oculares. Os resultados podem ser extrapolados para a pesquisa primária sobre a aplicabilidade da ARFI na avaliação do bulbo ocular em seres humanos.(AU)

Electroretinography and immunohistochemistry of retina in rabbits treated with sildenafil citrate / Eletrorretinografia e imuno-histoquímica da retina de coelhos tratados com citrato de sildenafil

Sildenafil citrate is a type-5 phosphodiesterase inhibitor (PDE-5), able to inhibit type-6 phosphodiesterase (PDE-6) as well, providing clinical benefits and paraeffects, some of them potentially related to the retina. The effects of the sildenafil on the retrobulbar and retinal circulation were studied in 27 adult male rabbits of the White New Zealand breed. The electric activity of the retina was evaluated before and at the end of the treatments, and immunohistochemistry studies were conducted. An amplitude increase of the b wave was found in the mixed response of cones and rods after 7 days of treatment with sildenafil citrate. However, in the other evaluations and periods, the values did not differ from the basal ones. Through immunohistochemistry, no significant decrease of the expression of PDE-5 and PDE-6 proteins was observed. Based on the results obtained, it is possible to admit that the sildenafil citrate did not change the expression of PDE-5 and PDE-6, neither the electroretinographic activity of the retina of male rabbits of the White New Zealand breed.

O citrato de sildenafil é um inibidor da fosfodiesterase do tipo 5 (PDE-5), capaz de inibir também a fosfodiesterase do tipo 6 (PDE-6), proporcionando benefícios clínicos e paraefeitos, alguns deles potencialmente relacionados à retina. Foram estudados efeitos do sildenafil sobre a circulação retrobulbar e a retiniana em 27 coelhos machos adultos, da raça Nova Zelândia Branco. Avaliou-se a atividade elétrica da retina antes e ao término dos tratamentos e realizaram-se estudos à imunoistoquímica. Encontrou-se aumento da amplitude da onda b na resposta mista de cones e de bastonetes, após 7 dias de tratamento com citrato de sildenafil. Entretanto, nas demais avaliações e períodos, os valores não divergiram dos basais. Pela imunoistoquímica, não se observou diminuição significativa da expressão das proteínas PDE-5 e PDE-6. Com base nos resultados obtidos, é possível admitir que o citrato de sildenafil não alterou a expressão de PDE-5 e PDE-6, tampouco, a atividade eletrorretinográfica da retina de coelhos machos da raça Nova Zelândia Branco.